Key Takeaway
Appellate Division affirms Civil Court in Alleviation Medical v Allstate, clarifying insurer obligations for exhausted policy limits and verified claims under NY no-fault law.
This article is part of our ongoing coverage coverage, with 150 published articles analyzing coverage issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
Alleviation Med. Servs., P.C. v Allstate Ins. Co., 2021 NY Slip Op 08159 (2d Dept. 2021)
(1) “The defendant appeals, and we affirm, albeit on different grounds than those relied upon by the Civil Court or the Appellate Term.”
(2) However, “n insurer is not required to pay a claim where the policy limits have been exhausted” (see Hospital for Joint Diseases v State Farm Mut. Auto. Ins. Co., 8 AD3d 533, 534) since, where payments made by an insurer meet or exceed the policy limits, “its duties under the contract of insurance cease” (Presbyterian Hosp. in City of N.Y. v Liberty Mut. Ins. Co., 216 AD2d 448, 448; see 11 NYCRR 65-3.15).
(3) “n insurer must pay or deny only a verified claim—that is, a claim that has been verified to the extent compliance with section 65-3.5 dictates in the particular case—within 30 calendar days of receipt; and, conversely, is not obligated to pay any claim until it has been so verified” (Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d 294, 299). Once claims have been verified they are subject to the priority of payment regulation, 11 NYCRR 65-3.15 (see Nyack Hosp. v General Motors Acceptance Corp., 8 NY3d at 300).
Free Consultation · No Fee Unless We Win
Does this apply to your situation?
Every case is different. Get a free, confidential case review from an experienced attorney who can tell you exactly where you stand.
(4) “While the defendant submitted records indicating that the subject no-fault policy had been exhausted in 2013, the defendant’s submissions failed to establish its prima facie entitlement to judgment as a matter of law. Although the defendant submitted an affidavit from one of its employees that set forth the defendant’s ordinary business practice of receiving, recording, and denying no-fault claims from medical providers, the affidavit is bereft of any specific information regarding this claim. The defendant failed to submit the no-fault application, verification, any request for verification, or any denial associated with the plaintiff’s claim for payment.”
(5) “Accordingly, there are issues of fact remaining as to when the claim was denied, and the basis and efficacy of the denial”
So we know that the policy was exhausted and that this was not enough. Yet, the Court does not want to tell us the significance of any of this. I suppose the record on this case was not clean and the Court got to kick the can down the road.
Related Articles
- Understanding collateral estoppel in no-fault insurance coverage disputes
- When loss is not covered as an insured event under policy terms
- Proving motor vehicle accidents through business records and documentation
- Material misrepresentations in insurance claims and coverage defenses
- New York No-Fault Insurance Law
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Insurance Coverage Issues in New York
Coverage disputes determine whether an insurance policy provides benefits for a particular claim. In the no-fault context, coverage questions involve policy inception, named insured status, vehicle registration requirements, priority of coverage among multiple insurers, and the applicability of exclusions. These articles examine how New York courts resolve coverage disputes, the burden of proof on coverage defenses, and the interplay between regulatory requirements and policy language.
150 published articles in Coverage
Keep Reading
More Coverage Analysis
IME no-show is a policy defense triggering the hourly attorney fee provision
Learn how IME no-show defenses trigger hourly attorney fee provisions in NY no-fault insurance. Court rules failure to attend IME is policy defense.
May 22, 2021
Contractual deemer
New York courts examine when out-of-state insurers can avoid no-fault coverage obligations through contractual deemer provisions and policy language analysis.
Apr 24, 2021
Policy Exhaustion (again) must comport with the priority of payment regimen
New York Court rules on policy exhaustion timing requirements in no-fault insurance cases, emphasizing proper demonstration of coverage limits at claim completion.
Jun 10, 2017
It did not work the second time around
Interboro v Johnson required factual proof for a default judgment. Jason's 2014 comparisons now include the later reversal of the Arnica ruling.
Dec 4, 2014
Oh Pearl
Grant v United Pavers: supported competing medical opinions saved most claims, but not the historical 90/180-day theory.
Jan 17, 2012
District Court Found That a Detailed Affidavit Was Sufficient to Show That the Vehicle Was Not Involved in a Motor Vehicle Accident
Learn how a detailed affidavit successfully proved a vehicle was not involved in a motor vehicle accident in Nassau County District Court.
Jan 9, 2010Was this article helpful?
Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a coverage matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
